Elif Ülker Akyildiz

Histopathological differentiation of skin lesions caused by electrocution, flame burns and abrasion

The aim of this study was to reveal histopathological features for differential diagnosis of skin lesions caused by electrocution, flames and abrasions. Based on the causes of the lesions, cases were assigned into three groups. Group 1 included 30 deaths from electric shock. Group 2 included 30 individuals with flame burns who died in the fires. Group 3 included 30 deaths from traffic accidents, from which the individuals had abrasions. Data from the crime scene investigations and macroscopic and microscopic findings from the autopsies allowed determination of the cause of death in all cases. The features of the lesions examined under the light microscope were intraepidermal separation, subepidermal (dermoepidermal) separation, coagulation necrosis in the epidermis, nuclear elongation in the epidermis, dark-staining epidermal nucleus, depth of homogenization in the dermis, and nuclear elongation in the epithelium of hair follicles. A significantly high rate of electrical lesions had intraepidermal separation. The rate of subepidermal separation was slightly more significant in flame burns. A significantly higher rate of electrical lesions had both intraepidermal and subepidermal separation. The rate of coagulation necrosis in the epidermis was significantly the highest in electrical lesions. Although the severity of nuclear elongation was the most significant in electrical lesions, varying degrees of nuclear elongation in the epidermis were present in all three groups. Dark staining of the epidermal nuclei was present in all lesions except for one electrical lesion, though the severity of staining was significant in the abrasion group. The depth of homogenization was slightly more significant in the abrasion group. The rate of nuclear elongation in the epithelium of the hair follicles was significantly lower in the abrasion group. The results of this study revealed that certain morphological changes determined under a light microscope could help the differential diagnoses of electrical lesions, flame burns and abrasions.

The Diagnostic Utility of Maspin in the Distinction between Malignant Mesothelioma and Pulmonary Adenocarcinoma

Immunohistochemistry is frequently employed to differentiate between malignant mesothelioma (MM) and pulmonary adenocarcinoma (AC) infiltrating the pleura, but there is uncertainty as to which antibodies are most useful. The present study investigated the presence of the serine protease, maspin, in epithelioid MMs and evaluated the diagnostic utility of maspin for the differential diagnosis between epithelioid MM and pulmonary AC with pleural involvement. The results showed more frequent maspin immunostaining among AC cases compared with MM cases. Maspin positivity was significantly higher among AC cases with respect to both the extent and intensity of staining. A significant difference also existed between the two tumour types with respect to the overall maspin score. Despite these findings, the sensitivity and specificity of maspin positivity to detect AC were only 59% and 73%, respectively, indicating that detection of maspin is of no value for the differential diagnosis of AC and MM.

Pulmonary Alveolar Microlithiasis in a Textile Worker

Pulmonary alveolar microlithiasis is a rare lung disease characterized by small calculi, called calsispheritis, in the alveoli. The disease usually presents at age 20 to 30 years and is mostly diagnosed incidentally or detected on routine pulmonary roentgenograms. The radiologic findings are pathognomonic for the disease. Pulmonary alveolar microlithiasis most frequently appears in Turkey, followed by Italy. We present the case of a 29-year-old female textile worker found to have widespread micronodules after a routine pulmonary roentgenogram.

A Study of Palmar Dermatoglyphic Pattern in Patients of Epilepsy

Dermatoglyphic is a scientific study of epidermal ridges and their configuration on the volar skin. Dermatoglyphic variations in epilepsy cases may be suggestive of an external imprint of genetic variation. The present study has been undertaken to find out the existence of any correlation between dermatoglyphics and idiopathic epilepsy. The material consisted of 100 patients (75 males and 25 females) and 100 controls (50 males and 50 females). Dermatoglyphics were obtained by printing method. Parameters studied were a-b, a-d ridge count, palmar angle - ‘atd’ angle, and total finger ridge count (TFRC). There is no significant difference in ‘atd’ angle in epileptic patients as compared to control group. Difference in the ‘atd’ angle between patients and controls was also not found to be significant. In this study a statistically (P value<0.01) reduced a-b ridge count is observed in patients as compared to control. Similarly total finger ridge count is reduced in epileptic patients as compared to controls. Significant differences have not been observed from these dermatoglyphics features for concluding the genetic predisposition of epilepsy.

Sarcoid-Like Reaction Mimicking Nodal Spread of Lung Cancer in a Silica-Exposed Patient on Positron Emission Tomography/Computed Tomography: A Case Report

As a noninvasive modality, Fluorine-18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is an important first step to assess mediastinal lymph node (LN) status in malignant pulmonary lesions. However, incorrect upstaging may occur due to false-positive results. Determining N stage is of utmost importance, and will affect the treatment planning strategy. Presently described is a staging challenge with PET/CT in a silica-exposed patient who was evaluated for characterization of a lung mass. The mass had an intense FDG uptake and proved to be squamous cell lung cancer (squamous cell carcinoma [SCC]) after a lobectomy. Histopathology revealed non-caseating granulomas representing sarcoid-like reaction (SLR) in non-calcified hypermetabolic mediastinal-hilar LNs. The significance of such reactions lies in how they can give a false impression of upstaging on the initial PET/CT or mimic disease progression after treatment. As an underlying clinical manifestation, occupational history is also discussed as a confounding factor for a benign cause of mediastinal lymphadenopathy. Awareness of tumor-related SLR is needed to avoid false positive PET/CT interpretation. To obtain histological confirmation of LNs for accurate staging in such a circumstance is also emphasized.

Molecular Markers for Patients with Thymic Malignancies: not Feasible at Present?

BACKGROUND Thymomas and thymic carcinomas are rare malignancies and devising clinically effective molecular targeted therapies is a major clinical challenge. The aim of the study was to analyze BLC2 and vascular endothelial growth factor receptor (VEGFR) expression and KRAS and EGFR mutational status and to correlate them with the clinical characteristics of patients with thymomas and thymic carcinomas. MATERIALS AND METHODS A total of 62 patients (mean age: 50.4 ± 13.2 years) with thymomas and thymic carcinomas were enrolled. The expression of BLC2 and VEGFR in tumor cells and normal tissues was evaluated by RT-PCR. The mutational status of the KRAS and EGFR genes was investigated by PCR with sequence specific primers. RESULTS The BLC2 and VEGFR expression levels did not differ significantly between tumor and normal tissues. Moreover, there were no clearly pathogenic mutations in KRAS or EGFR genes in any tumor. None of the molecular markers were significantly related to clinical outcomes. CONCLUSIONS Changes in levels of expression of BLC2 and VEGFR do not appear to be involved in thymic tumorigenesis. Moreover, our data suggest that KRAS and EGFR mutations do not play a major role in the pathogenesis of thymomas and thymic carcinomas.

Why did the patient die? The relationship between ambulance accidents and death of patients: Forensic medical issues

This articles aim is investigating traumatic consequences of ambulance accident on patients and discussing difficulties to give a decision about the relation between death and accident at these cases. The cases were selected among the forensic medical reports concluded between 1996 and 2005 years. They were documented for age, sex, causes of urgent call, localization and extent of traumatic lesion, properties of events and board decisions. A total of 21 cases were found. 15 cases died on the day of the accident. Skin injuries at head (8 cases) and legs (6 cases) were most common traumatic lesions. Totally 6 deaths were found related with ambulance accident. Death of patient after ambulance accidents may not be associated easily to the accident. Delay due to accident or concomitant contributing medical conditions may also facilitate the death in this type of cases. Reliable medical records were needed for accurate medicolegal evaluation.

Interinstitutional review of slides for forensic pathology: types of inconsistencies.

Because of the specific structure of forensic medicine in Turkey, reexamination of histopathologic specimens is a frequent practice. The aim of the present study is the assessment of microscopic diagnostic consistency in forensic pathology between different laboratories. Reports of the Council of Forensic Medicine between 2001 and 2004 were examined, and 150 cases with second pathologic examination were found. Results of histopathologic reports from peripheral laboratories were compared with those made by the Council pathologists with regard to diagnostic consistency. Consistency was assessed in 3 groups and 1 subgroup. Group 1, consistent and minor inconsistency; includes a major consistency subgroup. Group 2, major inconsistency, is the second diagnosis which is lethal; group 3, major inconsistency, is the first diagnosis which is lethal. The lung was found to be the organ with the highest frequency of diagnostic major inconsistency (group 2 and 3) and major consistency. Bronchopneumonia was the most common diagnosis. The brain had the highest frequency of intercenter diagnostic overall consistency (90.2%, group 1). Myocardial infarction was the diagnosis most frequently rejected on reevaluation (group 3). In conclusion, forensic pathology requires different experience than surgical ones. In cases of discrepancy between the anamnesis of the lethal event and pathologic findings, reevaluation of specimen is mandatory to avoid any diagnostic errors. Quality assurance systems with all include internal and external control mechanisms will improve the diagnostic reliability.

Adli Otopsilerde Kardiyomiyopatiye Bağlı Kalp Ölümleri

Kardiyomiyopatiler kalp kas›n›n nedeni bilinmeyen hastal›klar›d›r. Primer miyokardial kardiyomiyopatiler bafll›ca dilate, hipertrofik, restriktif, obliteratif ve ARVC alt gruplar›ndan oluflmaktad›r. Çal›flman›n amac›, genç eriflkin ani ölüm olgular›nda çok s›k olmayan bu patolojinin makroskopik ve mikroskopik özelliklerini tan›mlamakt›r. 2003-2006 y›llar› aras›nda Adli T›p Kurumu Morg ‹htisas Dairesi’nde otopsileri yap›lan 5’i erkek, 6’s› kad›n olan yafl aral›¤› 15-35 aras›nda de¤iflen 11 olgu çal›flmaya al›nd›. Otopside al›nan kalp örneklerinin patolojik de¤erlendirilmesi sonucunda 7 olgu hipertrofik kardiyomiyopati, 3 olgu dilate kardiyomiyopati, 1 olgu amiloid birikimine ba¤l› restriktif kardiyomiyopati olarak de¤erlendirildi. Olgular›n toksikolojik incelemesinde herhangi bir maddeye rastlanmad›. Ölüm nedenleri kardiyomiyopatiye ba¤l› kardiyovasküler kaynakl› ölüm olarak de¤erlendirildi. fiüpheli ani ölüm olgular›nda gerçek ölüm nedenini ortaya koymak olay›n adli boyutunu do¤ru bir flekilde de¤erlendirmek aç›s›ndan önemlidir. Genç eriflkinlerde ani ölüm olgular›nda kardiyovasküler kaynakl› ölümleri araflt›r›rken kardiyomiyopati tan›s› koymak ancak kalbin ayr›nt›l› makroskopik ve mikroskopik incelenmesi ile mümkündür. Anahtar kelimeler: Otopsi, ani ölüm, kalp, kardiyomiyopatiKardiyomiyopatiler kalp kasinin nedeni bilinmeyen hastaliklaridir. Primer miyokardial kardiyomiyopatiler baslica dilate, hipertrofik, restriktif, obliteratif ve ARVC alt gruplarindan olusmaktadir. Calismanin amaci, genc eriskin ani olum olgularinda cok sik olmayan bu patolojinin makroskopik ve mikros-kopik ozelliklerini tanimlamaktir. 2003-2006 yillari arasinda Adli Tip Kurumu Morg Ihtisas Da-iresi’nde otopsileri yapilan 5’i erkek, 6’si kadin olan yas araligi 15-35 arasinda degisen 11 olgu calismaya alindi. Otopside alinan kalp orneklerinin patolojik degerlendirilmesi sonucunda 7 olgu hipertrofik kardiyomiyopati, 3 olgu dilate kardiyomiyo-pati, 1 olgu amiloid birikimine bagli restriktif kardiyomiyopati olarak degerlendirildi. Olgularin toksikolojik incelemesinde herhangi bir maddeye rastlanmadi. Olum nedenleri kardiyomiyopatiye bagli kardiyovaskuler kaynakli olum olarak degerlendirildi. Şupheli ani olum olgularinda gercek olum nedenini ortaya koymak olaym adli boyutunu dogru bir sekilde degerlendirmek acisindan onemlidir. Genc eriskinlerde ani olum olgularinda kardiyovaskuler kaynakli olumleri arastirirken kardiyomiyopati tanisi koymak ancak kalbin ayrintili makroskopik ve mikroskopik incelenmesi ile mumkundur.Anahtar kelimeler: Otopsi, ani olum, kalp, kardiyomiyopati

Adli Otopsilerde Kemik İliğinde Yaşa Bağlı Sellülarite Değişiklikleri

SUMMARY Knowledge of the normal variations with aging of the bone marrow cellularity is essential for the interpretation of bone marrow features. We performed a histological study using biopsy samples of bone marrow obtained from medicolegal autopsies ranging from first to eighth decades. As a matter of increasing age, an increasing fat tissue fraction was observed.